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ABSTRACT: Precise localization and surgical excision is the therapeutic strategy for insulinomas. However, it is often difficult to localize the insulinomas, because of their small size. Surgeons may not localize and remove all of them together, particularly in patients with multiple insulinomas. We reviewed our experience to confirm the efficacy of blood glucose and intraoperative immunoreactive insulin (IRI) monitoring for surgical management of insulinomas.
Thirty-nine patients with insulinoma were surgically treated in our department. Perioperative blood glucose monitoring was performed in 14 patients, intraoperative quick IRI assay of the peripheral blood in 10 patients, and assay of a portal sample in 4 patients by an IMX analyzer.
Rebound response of blood glucose to insulinoma removal was not always noted (8/14; 57%). Seven of ten patients showed a decrease of peripheral serum IRI levels within 15 minutes after removal of the insulinoma. The other two patients showed a rebound response of peripheral blood glucose or portal IRI. All the patients who had intraoperative monitoring of peripheral blood and peripheral and portal IRI had no recurrent insulinoma syndrome after surgical removal of their insulinomas.
Combined monitoring of peripheral blood glucose and peripheral and portal IRI are helpful in the surgical management of insulinomas, as they can indicate that no insulinoma remains.
Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2001; 11(4):193-9. · 1.40 Impact Factor
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ABSTRACT: We discussed the possibility of the screening programs for the early detection in carcinoma of the pancreas. Several trials of screening have been conducted for the outpatients with diabetes mellitus, jaundice or upper abdominal pain by means of serum erastase-1, amylase and CA19-9 levels and the ultrasonography. The trials could detect 37 patients of 4250 (1.3%), 47 of 423,905 (0.011%) and 89 of 3585 (2.4%) with carcinoma of the pancreas. Despite effective screening program is not available, the screening carries the potential for improvement of the resectability and the mortality in the patients with carcinoma of the pancreas.
Nippon rinsho. Japanese journal of clinical medicine 06/1996; 54(5):1431-4.
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ABSTRACT: Ectopic adrenocorticotropic hormone-producing islet cell tumors of the pancreas (ACTH-ICT) are a rare cause of Cushing's syndrome with a severe and rapidly progressive clinical course.
Charts were reviewed on all patients evaluated and treated for proven Cushing's syndrome caused by ACTH-ICT (n = 12), specifically for the role of surgery in the management of this disease.
Ten (83%) of twelve patients with ACTH-ICT had liver metastases at the time of diagnosis (eight of eight with Zollinger-Ellison syndrome, two of four without Zollinger-Ellison syndrome). Surgical management of the primary tumor included three patients who underwent distal pancreatectomy combined with hepatic resection and one patient who underwent laparoscopic enucleation of a tumor from the pancreatic tail. Eight of twelve patients underwent bilateral adrenalectomy to control symptoms of Cushing's syndrome, including three patients who underwent concurrent distal pancreatectomy and hepatic resection. Six of twelve patients died of the disease within 2 1/2 years of diagnosis, four are alive with progressive hepatic metastases, and one has biochemical evidence of disease.
ACTH-ICT of the pancreas is an aggressive tumor, particularly when there is coproduction of gastrin. The benefit of aggressive surgical resection of primary or metastatic ACTH-ICT has not been established. However, palliative bilateral adrenalectomy is justified, because no patients had biochemical cures after aggressive surgical resection in this series.
Surgery 01/1996; 118(6):1125-30. · 3.10 Impact Factor
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ABSTRACT: By measuring the doubling time of liver metastasis, the authors investigated the possibility of occult liver metastasis at the time of pancreatectomy in patients with pancreatic carcinoma. We calculated tumor doubling times of liver metastases in six patients after pancreatectomy for periampullary carcinoma and compared with cell doubling times. We also calculated the diameters of the occult liver metastases at the time of pancreatectomy on the assumption that the growth rates of liver metastasis were constant. Tumor doubling times of liver metastases in six patients were 34, 32, 318, 108, 78, and 27 d, respectively. In two of these patients, tumor doubling times, compared with cell doubling times of 51 and 52 h for PK-36 and PK-59 established from the same patients with carcinoma of the pancreas, were about 15 times as long as those of cultured cell lines. The calculated sizes of the occult liver metastases at the time of pancreatectomy in these six patients were 2.4, 0.14, 19.0, 8.2, 3.5, and 4.2 mm. In five of these six patients, the calculated sizes were in the range between 10 microns and 1 cm. These results indicated occult liver metastases had already existed in patients with carcinoma of the pancreas at the time of pancreatectomy and were too small to be detected by imaging technique. We cannot improve survival rates in carcinoma of the pancreas by surgical management alone. For further improvement in survival rate of patients with carcinoma of the pancreas to occur, effective adjuvant therapies to prevent liver metastases must complement surgical management.
International journal of pancreatology: official journal of the International Association of Pancreatology 05/1995; 17(2):139-46.
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ABSTRACT: OPERATION: Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy of the body and tail of the pancreas (LR-LPJ) was designed to improve decompression of the head of the pancreas, which often was not drained well by standard longitudinal pancreaticojejunostomy. This was achieved by excising the head of the pancreas overlying the ducts of Wirsung and Santorini, and duct to the uncinate, along with their tributary ducts.
Pain was assessed on a scale of 1 to 10, with 10 being most severe. Narcotic intake was considered minimal-Vicodin equivalent (hydrocodone bitartate, 5 mg, acetaminophen, 500 mg; Vicodin, Knoll Pharmaceuticals, Whippany, NJ) once or twice/month; moderate--Vicodin weekly daily; and major--meperidine hydrochloride (Demerol, Winthrop Pharmaceuticals, New York, NY) weekly or daily.
Pain relief in 47 patients was excellent (74.5%), improved in 12.75%, and unimproved in 12.75%. Endocrine status in 45 patients was as follows: 69% were not diabetic, and 20% were diabetic preoperatively and postoperatively. Postoperatively, 11% had progression of their diabetes. Exocrine function was not worsened and may have been improved in some patients. Sixty-four percent of 39 patients gained an average of 15.3 pounds. Fifty-nine percent of patients were not working preoperatively or postoperatively.
The LR-LPJ provides good pain relief with a modest increase in endocrine and exocrine insufficiency and a significant increase in weight. Even when relieved of pain, patients seldom return to the work force.
Annals of Surgery 11/1994; 220(4):492-504; discussion 504-7. · 7.49 Impact Factor
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ABSTRACT: Sixty-seven of 207 patients with pancreatic and peripancreatic malignancies underwent preoperative fine needle aspiration cytology (FNA), and 24 patients underwent intraluminal endoscopic biopsies. All patients had confirmation of the diagnosis of malignancy either at operation, autopsy, or by clinical follow-up. FNA of liver metastases was positive for malignancy in 12 of 12 patients. FNA of the pancreas was performed on 44 patients with pancreatic adenocarcinoma and 11 patients with other pancreatic or peripancreatic malignancies. The diagnosis of cancer was established by FNA in 32 of 44 (72.4%) patients with pancreatic adenocarcinoma and 1 of 11 patients (9.1%) with other pancreatic or peripancreatic malignancies. In the patients with pancreatic adenocarcinoma, 17 of 18 patients (94.4%) who had no operative intervention, 12 of 18 (66.7%) patients who had palliative bypass procedures, and 3 of 8 (37.5%) patients resected had positive FNA. Eighteen of 24 patients (75%) who underwent intraluminal endoscopic biopsies, and 11 of 15 (73.3%) with ampullary carcinoma were positive. We believe that FNA is of limited value in the diagnosis of small resectable tumors of the pancreas as it identified cancer in only 3 of 8 patients in whom it was employed. False negative FNA may delay the diagnosis and treatment of pancreatic malignancies. Patients in whom there is a high index of suspicion of pancreatic or peripancreatic malignancy based on clinical presentation, CT scan, or ERCP assessment do not require preoperative, histologic proof of malignancy prior to pancreaticoduodenectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
International journal of pancreatology: official journal of the International Association of Pancreatology 09/1994; 16(1):17-21.
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Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 07/1991; 88(6):1384-7.
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ABSTRACT: By measuring the doubling time both of clinical liver metastases and cultured human pancreatic cancer cell lines, we studied the possibility of occult liver metastases at the time of pancreatectomy in patients with pancreatic cancer. Doubling times of 3 pancreatic cancers were obtained from the measurements of size of liver metastases after pancreatectomy and those were compared with those of cultured human pancreatic cancer cell lines established from two of these cases. Doubling time of liver metastases were about fifteen times as long as those of cultured cell lines. On the assumption that growth rates of liver metastases were constant, the size of liver metastases at the time of pancreatectomy was calculated in three cases. The calculated sizes of these liver metastases were 140 microns, 2.4 mm, and 8.3 mm respectively. These results indicate that occult liver metastases have already existed in patients with pancreatic cancer even though they were clinically undetectable at the time of operation. And some adjuvant therapies against occult liver metastases are necessary for achievement of the better prognosis.
Nippon Geka Gakkai zasshi 06/1991; 92(5):562-6.
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ABSTRACT: Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (LR-LPJ) was performed in 50 patients, the results of which were reported at the American Surgical Association meeting in San Antonio, Tex., on April 8, 1994. The operation was not performed in patients where ducts were less than 3.5 mm in diameter. There were no operative deaths. Forty-seven patients were followed an average of 37 months. Forty-three of the 50 patients were alcoholic. Pseudocysts were present in 50% of the patients. Thirty-five intra-abdominal operations had previously been performed on 23 patients. Preoperatively, all patients underwent computed tomography. Endoscopic retrograde cholangiopancreatography was performed in 82% of patients and angiography in 64% of patients. Preoperatively, all patients had pain. Common bile duct obstruction was present in 8% of patients. The average length of hospital stay was 18.7 days. Postoperative complications occurred in 22% of patients. Pain relief was judged excellent in 74.5%, improved in 12.75%, and unimproved in 12.75%. The pain assessment included use of a pain scale and narcotic usage. Progression of diabetes occurred in patients in the immediate postoperative period and in 3 patients at 3, 16, and 22 months. Exocrine function based on presence of steatorrhea improved in 10 patients (22%) and deteriorated in 5 (11%). Weight gain was noted in 25 patients and weight loss in 13 patients. Few patients not working preoperatively returned to work postoperatively (15.9%). Aside from pain relief, the operation is also useful in the management of patients with stricture of the intrapancreatic portion of the common duct, pseudocysts, pancreatic ascites, and pancreatic fistulas. LR-LPJ is not indicated in patients in whom there is a suspicion of pancreatic cancer, nor in patients with splenic vein thrombosis and left-sided portal hypertension or pseudoaneurysm of the peripancreatic vessels in the absence of some additional procedure to correct these problems. Patients with a small main pancreatic duct < 3.5 mm having common duct and duodenal obstruction are best treated by pancreaticoduodenectomy. Patients with a small main pancreatic duct whose disease is limited to the body and tail of the pancreas are best treated by distal pancreatectomy.
Digestive Surgery. 08/1970; 11(3-6):325-330.
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ABSTRACT: The role of Frey's operation as extended pancreatic duct drainage operation was evaluated in patients with chronic pancreatitis.
206 patients with chronic pancreatitis were surgically treated, evaluated and followed for a minimum period of 6 months, in order to ascertain the status of pancreatic function and pain relief for both pancreatic duct drainage operations, including Frey's operation, and pancreatectomy.
Pain relief was established in 62 out of 86 patients (72.1%) undergoing pancreas duct drainage operation, in 51 out of 65 patients (78.5%) undergoing pancreatectomy. Fourteen out of 16 patients undergoing standard pancreaticojejunostomy with either persistent or alleviated pain had impacted calculi or pseudocysts in the pancreatic head and uncinate process preoperatively. Seventeen patients (16.3%) maintained normal glucose tolerance. Improvement was noted in 15 patients (14.4%) and in 27 patients the condition worsened (26.0%). The 10 years survival ratio in patients with diabetes mellitus preoperatively was 67.5% significantly lower than in patients without diabetes mellitus, 81.3% (p = 0.0029). Frey's operation was performed in 11 patients, providing satisfactory pain relief and preserving pancreatic exocrine and endocrine function.
Frey's procedure should be considered as a new standard procedure in patients with pancreatic head complications and ductal dilatation in chronic pancreatitis.
Hepato-gastroenterology 44(18):1547-53. · 0.66 Impact Factor
